Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf .... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in)
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(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 1,465,660 | 1,243,727 | 1,223,663 | 951,239 | 879,280 | 5,763,569 |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | 838,098 | 1,815,616 | 2,553,995 | 4,526,085 | 4,972,717 | 14,706,511 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 2,634 | 1,726 | 1,785 | 5,991 | 2,736 | 14,872 |
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | 2,306,392 | 3,061,069 | 3,779,443 | 5,483,315 | 5,854,733 | 20,484,952 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 20,484,952 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 2,306,392 | 3,061,069 | 3,779,443 | 5,483,315 | 5,854,733 | 20,484,952 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 4,085 | 4,085 | ||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 4,085 | 4,085 | ||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 2,306,392 | 3,061,069 | 3,779,443 | 5,483,315 | 5,858,818 | 20,489,037 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2024 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
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2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
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5
Remaining underdistributions for years prior to 2024, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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6
Remaining underdistributions for 2024. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2025. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software Version: |
| Return Reference | Explanation |
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| Form 990, Part III, Line 1 - Organization Mission | To provide quality treatment for those qualified persons who are addicted to opiates and related chemicals. Overmountain Recovery's philosophy is the goal of treatment should be to assist these individuals in attaining the highest level of functioning possible in physical, emotional, vocational and social domains. |
| Form 990, Part III, Line 4a - Program Service Accomplishments | East Tennessee Healthcare Holdings, Inc. d/b/a Overmountain Recovery (OMR) is a not-for-profit outpatient opioid treatment, drug rehabilitation program in Johnson City, Tennessee. In 2016, Mountain States Health Alliance (MSHA) and East Tennessee State University Research Foundation (ETSU) formed OMR to treat people in its service area with heroin, morphine and prescription opioid addictions, including high-acuity individuals with co-occurring mental and physical health conditions, as well as vulnerable populations such as women with substance-exposed pregnancies. The service area consists of 39 cities and 11 counties, including Carter, Greene, Hancock, Hawkins, Johnson, Sullivan, Unicoi and Washington in Tennessee and Lee, Scott and Washington in Virginia, including the City of Bristol, Virginia. According to the Tennessee Department of Health's report "2023 Tennessee Drug Overdose Deaths and "2023 Drug Overdose Hospital Discharges in Tennessee", in 2023, there were 3,616 overdose deaths. While representing only 36 percent of the population in Tennessee based on the most recent 2020 census, East Tennessee represented 44 percent of all overdose deaths in Tennessee in 2023. Over the five-year period from 2019-2023, the percentage of decedents who filled a prescription in the Controlled Substance Monitoring Database in the 60 days before death decreased continually with the exception of a plateau between 2022 and 2023. These trends reflect the decrease in deaths involving prescription opioids and increase in deaths involving illicit opioids, such as fentanyl, the current driving force of the epidemic of overdose deaths. Neonatal Abstinence Syndrome (NAS) or Neonatal Opioid Withdrawal Syndrome (NOWS) may occur when a woman uses opioids during pregnancy. As stated in the Tennessee Department of Health's report "Neonatal Abstinence Syndrome in Tennessee 2022", the rate of cases of NAS per 1,000 live births reported to the Tennessee Department of Health increased from 9.3 in 2021 to 9.8 in 2022. Since 2019, there have been fluctuations in the number of cases reported but there has not been a meaningful trend during those years. OMR's Opioid Treatment Program represents a unique comprehensive, innovative, holistic model of care for this patient population by bringing together the local academic and research resources of ETSU; coupled with the medical care expertise and capital resources of MSHA. These two entities have also contracted with Frontier Health to provide therapeutic and recovery-based services. OMR is only one component of a larger focus to incorporate education, outreach, research, and evaluation, all aimed at making a significant difference in the management of the chronic disease of addiction. OMR is an entity that emphasizes evidence-based, long-term treatment that addresses substance use disorder (SUD) as a chronic, relapsing disease. Overmountain is focused not just on providing a service, but on making the community a healthier and safer place to live, work, learn and do business by reducing the burden of addiction plaguing its service area. Both ETSU and MSHA have long-time roots in the community. ETSU, founded in 1911, is a state-supported, coeducational institution. ETSU serves approximately 14,000 undergraduate, graduate, medical and pharmacy students each year. Although most students are from Tennessee and the surrounding southeastern region, nearly every state and 80 countries are also represented. The main campus is in Johnson City, Tennessee with off campus sites in Kingsport and Sevierville in Tennessee, Abingdon in Virginia, and Asheville in North Carolina. ETSU has a strong health care focus with colleges of pharmacy, clinical and rehabilitative health sciences, nursing, public health, and medicine. Mountain States Health Alliance, founded in 1998, is part of a large, integrated, not-for-profit health care system based in Johnson City, Tennessee. On February 1, 2018, Mountain States Health Alliance (MSHA) and Wellmont Health System (WHS) merged to form Ballad Health (Ballad), a tax-exempt entity and parent company of MSHA and WHS. Ballad is an integrated healthcare delivery system consisting of 20 hospitals in Northeast Tennessee and Southwest Virginia, including a Level 1 Trauma Center, dedicated children's hospital, several community hospitals, four critical access hospitals, a behavioral health hospital, an addiction treatment facility, long-term care facilities, home care and hospice services, retail pharmacies, outpatient services and a comprehensive medical management corporation. Ballad works closely with an active independent medical community and community stakeholders to improve the health and well-being of over one million people in 29 counties of the Appalachian Highlands in Northeast Tennessee, Southwest Virginia, Northwest North Carolina, and Southeast Kentucky. OMR is committed to its patients' recovery. OMR provides care that is customized to their patients' personal needs and takes into consideration housing, education, employment, legal issues, security, transportation and other areas in order to gain a complete picture of the individual. Another key facet of patient-centric approach to care is to have a reliable way of getting input from patients. OMR convenes focus groups of patients who meet quarterly with the director. The average monthly census increased from 685 patients in FY24 to 800 in FY25, which is an increase of 17%. OMR provided warm coats to over 50 individuals for Thanksgiving in 2024 and plans are underway to coordinate with Second Harvest Food bank to provide food for families in need for Thanksgiving 2025. The team at OMR donated all the items provided to patients. PROMOTE COMMUNITY HEALTH: OMR's Community Advisory Committee meets quarterly to keep the community abreast of what is happening at OMR. This committee is comprised of members who reside in the community, as well as churches, businesses, and Ballad leadership. ETSU has an addiction medicine fellowship and OMR is a participating site. During FY25, three fellows spent time at OMR. This program will assist in preparing physicians to treat persons with substance use and behavioral disorders in OMR's service area. OMR also has a Clinical Affiliation Agreement with ETSU to provide clinical experience to students enrolled in the Clinical Psychology program of ETSU. The agreement runs for one year and is a paid position. One student was at OMR during FY25 as part of this paid Clinical Affiliation Agreement. OMR continues to contract with the Department of Health to provide Hepatitis C rapid testing. OMR participated in several community events throughout the year. This included hosting an event to educate patients on resources available to them. OMR has a representative from Appalachian Highlands Care Network present five days a week receiving referrals from internal providers and working directly with patients to access community resources, including specialty care. OMR also provided access to an on-site Mobile Health Unit in FY25 on a monthly basis for 3 months. AWARDS AND RECOGNITIONS: Overmountain regularly measures and reports on the performance of its program. OMR tracks both efficiency and effectiveness measures. Because of this dedication to quality, OMR earned its first three-year accreditation from CARF (the Commission on the Accreditation of Rehabilitation Facilities) in August 2018. CARF three-year accreditation is the highest accreditation level awarded to organizations like Overmountain. OMR was resurveyed in July of 2021 and again received a three-year accreditation. Most recently in August of 2024 a resurvey was performed, and another three-year accreditation was earned. To receive three-year accreditation from CARF, organizations are put through a rigorous ongoing process that includes, among other requirements, live on-site surveys. These requirements ensure OMR's program meets CARF's high standards of quality and accountability. Overmountain Recovery was also awarded the State Opioid Response (SOR) grant which was renewed in October 2025 and extended through fiscal year 2026. The SOR grant is a hub and spoke model with Overmountain being the first hub out of four across the state of TN. Spokes include Families Free, Frontier Health, Appalachian Counseling, CCS, and Red Legacy. This has allowed OMR to help many patients who could not otherwise afford treatment. The grant includes funding that allows patients assistance with transportation, social services, help pay utility bills, provide clothes for an interview, and community awareness of the services OMR provides for treatment of opioid addiction. |
| Form 990, Part V, line 1a | Ballad Health (BH), the parent organization of both East Tennessee Healthcare Holdings, Inc. (OMR) and one of its members Mountain States Health Alliance, filed Form 1096 on a consolidated basis for all subsidiaries that were required to file Forms 1099-MISC/NEC. OMR reimburses BH for all expenses related to vendor payments and the expenses are recorded on OMR's books. |
| Form 990, Part V, Line 2a | Mountain States Health Alliance (MSHA) along with East Tennessee State University Research Foundation are the sole members of East Tennessee Healthcare Holdings, Inc. MSHA and its parent organization, Ballad Health, Inc. have entered into a management services agreement which includes performance of purchasing functions, inclusive of payment of salaries and benefits as well as the ability to contract for clinical service staff. East Tennessee Healthcare Holdings, Inc. reimburses Ballad Health for all salary and benefits related to its team members and the contracted clinical staffing arrangements. These expenses are recorded on East Tennessee Healthcare Holdings Inc.'s books. |
| Form 990, Part VI, Section A, line 6 | The organization has two members: Mountain States Health Alliance and East Tennessee State University Research Foundation both of which are 501(c)(3) public charities. |
| Form 990, Part VI, Section A, line 7a | Mountain States Health Alliance and East Tennessee State University Research Foundation each have the power to elect four of the eight voting board members. |
| Form 990, Part VI, Section B, line 11b | The Ballad Health Tax Department prepares and reviews the Form 990. During preparation other functional areas within the organization provide information and support to complete an accurate return. The return is reviewed by the organization's President and is provided in electronic form to all members of the Board of Directors prior to being filed with the IRS. |
| Form 990, Part VI, Section B, line 12c | Ballad Health policy requires Board of Directors and Board Committee members, the Executive Chair/President, and Executive Vice Presidents to complete a conflict of interest disclosure statement on an annual basis. Ballad Health policy also requires team members to complete an annual acknowledgement that they have read and understand the conflict of interest policy and they will complete a conflict of interest disclosure statement if they have a conflict of interest. Should a conflict arise, it is the responsibility of the conflicted individual to update his or her disclosure immediately. All meetings of the board or board committees have a standing agenda item first on the agenda titled "Conflicts of Interest". If a member of the board or board committee has a conflict of interest involving any issue on the board agenda, he or she must declare the conflict of interest during the period allotted for disclosure. If any issue arises during a meeting in which the board member has a conflict of interest, he or she must immediately declare the conflict. While each member of the board or board committee is responsible for disclosing conflicts of interest, it is also the responsibility of any board member aware of a conflict which has not been disclosed to ensure the board is made aware. The presiding officer of a board or board committee meeting may ask a conflicted member to excuse themselves from the meeting during the discussion related to the issue with which the conflict of interest applies. Under no circumstances shall a member vote on a matter that gives rise to a potential conflict. This applies to all Ballad Health organizations. |
| Form 990, Part VI, Section C, line 19 | Governing documents and conflict of interest policy are made available upon request to appropriate parties requesting them. Financial statements are made available upon request to appropriate parties requesting them, and they are made available to those parties who own indebtedness of the company on a quarterly basis. |
| Form 990, Part IX, line 11g | Medical Professional Services: Program service expenses 1,378,145. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,378,145. Environmental Services: Program service expenses 42,165. Management and general expenses 0. Fundraising expenses 0. Total expenses 42,165. Other: Program service expenses 62,147. Management and general expenses 0. Fundraising expenses 0. Total expenses 62,147. |
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